Adenocarcinomas of the esophagus and gastric cardia: medical conditions, tobacco, alcohol, and socioeconomic factors

• Published in: Cancer epidemiology, biomarkers & prevention Vol. 5; no. 10; pp. 761 - 768
• Main Authors: Z F Zhang, R C Kurtz, M Sun, M Karpeh, Jr, G P Yu, N Gargon, J S Fein, S K Georgopoulos, S Harlap
• Format: Journal Article
• Language: English
• Published: United States American Association for Cancer Research 01-10-1996
• Subjects: Adenocarcinoma - complications; Adenocarcinoma - epidemiology; Adenocarcinoma - pathology; Adult; Alcohol Drinking; Anemia, Iron-Deficiency - complications; Barrett Esophagus - complications; Body Mass Index; Cardia; Case-Control Studies; Esophageal Neoplasms - complications; Esophageal Neoplasms - epidemiology; Esophageal Neoplasms - pathology; Female; Humans; Hypertension - complications; Logistic Models; Male; Middle Aged; Multivariate Analysis; Risk Factors; Smoking; Socioeconomic Factors; Stomach Neoplasms - complications; Stomach Neoplasms - epidemiology; Stomach Neoplasms - pathology
• ISSN: 1055-9965; 1538-7755

Adenocarcinomas of the esophagus and gastric cardia have increased in incidence over the past 10-15 years in Western countries.
The cause for this increase in incidence is still unknown. Our study was designed to investigate potential risk factors for
adenocarcinomas of the esophagus and gastric cardia and to compare the risk profiles of a group of patients with this cancer
with those having distal stomach cancer. We studied 95 incident cases with the pathological diagnosis of adenocarcinomas of
the esophagus and gastric cardia, 67 patients with adenocarcinomas of the distal stomach, and 132 cancerfree controls. Patients
were seen at Memorial Sloan-Kettering Cancer Center from November 1, 1992 to November 1, 1994. Epidemiological data were collected
by a modified National Cancer Institute Health Habits History Questionnaire. Risk factors were analyzed using Mantel-Haenszel
methods and a logistic regression model. Hypertension was associated with a 2-fold increased risk of adenocarcinomas of esophagus
and gastric cardia after controlling for age, sex, race, education, pack-years of smoking, alcohol use, body mass index, and
total dietary intake of calories. Increased risk of adenocarcinomas of esophagus and gastric cardia was associated with age,
male gender, and Caucasian race. Tobacco smoking was related to a modest risk of adenocarcinomas of esophagus and gastric
cardia. In contrast, the risk of distal stomach cancer was associated with stomach ulcers and pack-years of cigarette smoking.
Iron deficiency was significantly associated with increased risk of both adenocarcinomas of the esophagus and gastric cardia
and adenocarcinomas of the distal stomach. No obvious associations were identified for occupational exposures, family history
of cancer, and physical activities. This study suggests that medical conditions such as hypertension and iron deficiency may
be related to the risk of adenocarcinomas of esophagus and gastric cardia and confirms the moderate risk associated with tobacco
smoking. Our results indicated an etiological heterogeneity with respect to risk factors identified between adenocarcinomas
of esophagus and gastric cardia and those of the distal stomach.